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Tuesday, December 29, 2015

New article in ERJ on Novel concepts in airway inflammation and remodelling in asthma!

The hallmark pathological features of asthma include airway eosinophilic
inflammation and structural changes (remodelling) which are associated
with an irreversible loss in lung function that tracks from childhood to
adulthood. In parallel with changes in function, pathological
abnormalities occur early, during the pre-school years, are established
by school age and subsequently remain (even though symptoms may remit
for periods during adulthood). Given the equal importance of
inflammation and remodelling in asthma pathogenesis, there is a
significant disparity in studies undertaken to investigate the
contribution of each. The majority focus on the role of inflammation,
and although novel therapeutics such as those targeted against T-helper
cell type 2 (Th2) mediators have arisen, it is apparent that targeting
inflammation alone has not allowed disease modification.

Therefore,
unless airway remodelling is addressed for future therapeutic
strategies, it is unlikely that we will progress towards a cure for
asthma. Having acknowledged these limitations, the focus of this review
is to highlight the gaps in our current knowledge about the mechanisms
underlying airway remodelling, the relationships between remodelling,
inflammation and function, remodelling and clinical phenotypes, and the
importance of utilising innovative and realistic pre-clinical models to
uncover effective, disease-modifying therapeutic strategies.

Monday, December 28, 2015

Cigarette smoking and asthma interact to induce important adverse effects on clinical, prognostic and therapeutic outcomes. Please read new article from Current Opinion in Pulmonary Medicine from our Greek friends dedicated to this hot Respiratory topic.

Purpose of review: The prevalence of active smoking in
adults with asthma is similar to the general population. Smoking asthma
is associated with poorer disease control, impaired response to
corticosteroid therapy, accelerated decline in lung function, and
increased rate of healthcare utilization. Current asthma guidelines do
not provide specific treatment advice for smoking asthmatic patients.
There is an urgent need for better understanding of the underlying
mechanisms and effective treatment for smoking asthmatic patients.

Recent findings: An association between both active and passive smoking and adult-onset asthma is supported by many studies.

The asthma-COPD overlap syndrome (ACOS) has recently
gained particular interest and smoking asthmatic patients should be
evaluated for ACOS.

Asthma is associated with increased risk of
cardiovascular comorbidities whereas smoking is an additional strong
independent risk factor for pulmonary and cardiovascular diseases.
Tobacco smoking and not asthma per se seems to be the reason of poor
prognosis, especially with regard to lung cancer, cardiovascular
diseases, and mortality in asthmatic patients.

Summary: Smoking asthma represents a common challenge
to the clinician both in terms of diagnosis and management. These
aspects have not been thoroughly evaluated and deserve further
investigation.

Thursday, December 24, 2015

Thank you for all your permanent help
and support in this hard year! We realized very useful things for
promotion of ALL Respiratory conditions! We are hoping that we will
continue this work with your help and in 2016!

The world’s first guidelines for chronic fungal lung infections for
doctors and laboratories have been published today, by the European
Respiratory Society (ERS) and the European Society of Clinical
Microbiology and Infectious Diseases (ESCMID).

Published today (23 December, 2015) in the European Respiratory Journal, these new guidelines describe the important features of this disease and provide comprehensive treatment recommendations.

Chronic pulmonary aspergillosis (CPA) is a subtle and insidious
problem in patients who already have damaged lungs. It kills about 80%
of sufferers over five years unless diagnosed and treated with long-term
antifungals. Across Europe, an estimated 240,000 people have CPA, and
worldwide around 3 million. The late stages of CPA (aspergilloma) are
familiar to respiratory specialists, but the early features are often
missed.

Major improvements in understanding this debilitating and ultimately
fatal disorder have resulted from research undertaken in Europe, India
and Japan over the past 10 years. However, no therapies are approved by
the European Medicines Agency (EMA) for treatment, and very few
diagnostic tests and therapies have been compared. In many parts of the
world, the basic tests required are not yet available.

Professor David Denning of the University of Manchester, who lead the
CPA guidelines group, said: “The UK National Health Service recognised
the challenges posed by these patients by setting up the National
Aspergillosis Centre and its associated laboratory the Mycology
Reference Centre in 2009. The experience gained from seeing hundreds of
patients has contributed to the quality of care, although much more
research and new oral antifungal drugs are required to reduce the marked
disability caused by CPA.”

Patient Michael Miller, aged 65 years from Leeds, described his
experience: “I had aspergillosis in 2006, which improved with a long
course of antifungal capsules. In 2012, I started to get worse and
worse, and it took 3 years to recognise recurrence of my aspergillosis.
By this time, I was so breathless and my x-ray was much worse.”

ESCMID President Professor Murat Akova stated: “I am delighted that
this groundbreaking clinical guideline has been published; the
management of chronic fungal infection, notably CPA, is difficult,
requiring a high level of laboratory and clinical expertise.

ERS Guidelines Director, Dr Marc Miravitlles, commented: “We welcome
the publication of this guideline, which provides key insights into the
main features of the disease and treatment recommendations. By
establishing this expert consensus on the topic, we aim to improve the
early diagnosis of CPA and increase recognition of the condition to
ultimately improve outcomes for patients.”

The guidelines are a product of a two-year collaboration between
ESCMID and ERS. In parallel to these CPA recommendations, ESCMID is
currently developing wider guidelines for invasive aspergillosis in
general, which will be published in due course. The latter are developed
by Professor Andrew Ullmann of the Julius Maximilian University of
Würzburg, chairman of ESCMID’s fungal infection study group EFISG.

Professor Ullmann commented: “This
is the first guideline on chronic pulmonary aspergillosis worldwide. It
is the result of another joint effort of ESCMID and ERS experts who, in a
truly interdisciplinary collaboration, prepared and published guidance
for colleagues on a group of complex diseases that is difficult to
manage. Aspergillosis is more than chronic lung infection and a larger
document addressing all aspects of aspergillosis infections is under
preparation by EFISG.” http://erj.ersjournals.com/content/early/2015/12/22/13993003.00583-2015

Editorial
from Guest Editor: Current Management of Sleep Apnea and Comorbidities -
See more at:
http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpuf

Editorial
from Guest Editor: Current Management of Sleep Apnea and Comorbidities -
See more at:
http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpuf

Tuesday, December 15, 2015

Background. The main symptomatic criterion to diagnose obstructive sleep apnea (OSA) is the level of daytime sleepiness. The Epworth Sleepiness Scale is a simple, self-administered questionnaire which provides a measurement of the subject’s general level of daytime sleepiness.The aim of this study was to investigate the factors that can predict daytime sleepiness in patients with sleep apnea.

Methods. 50 consecutive patients with obstructivesleep apnea were enrolled into the study. Age, gender, anthropometric and polygraphic data werethoroughly analyzed. In all subjects daily sleepiness was assessed by Epworth Sleepiness Scale.Results. The mean age of the subjects was 54.7±12.8 years, 82% males. The mean BMI was 31.9±6 kg/m2. Pearson correlation coefficient analysis demonstrates a significant positive correlation between the Epworth Sleepiness Scale and the desaturation index (r=0.31, p<0.01) and arterial hypertension (r=0.32, p<0.01). The forward stepwise regression analysis shows that the apnea hypopnea index and desaturation index are important predictors of daytime sleepiness in patients with obstructive sleep apnea which explains 40% of the Epworth Sleepiness Scale score.Conclusion. The desaturation index showed thestrongest correlation with the Epworth scale. According to the results of the backward stepwise multiple regression and logistic regression, the predictors for the level of daytime sleepiness are oAHI and index of desaturation. According to the analysis of the ROC curve, desaturation index is a predictor of a high specificity.

Saturday, December 12, 2015

Rationale: Pulmonary rehabilitation
(PR) has demonstrated physiological, symptom-reducing, psychosocial, and
health economic benefits for patients with chronic respiratory
diseases, yet it is underutilized worldwide. Insufficient funding,
resources, and reimbursement; lack of healthcare professional, payer,
and patient awareness and knowledge; and additional patient-related
barriers all contribute to the gap between the knowledge of the science
and benefits of PR and the actual delivery of PR services to suitable
patients.

Objectives: The objectives of this document are
to enhance implementation, use, and delivery of pulmonary rehabilitation
to suitable individuals worldwide.Methods: Members of the
American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and
the European Respiratory Society (ERS) Rehabilitation and Chronic Care
Group established a Task Force and writing committee to develop a policy
statement on PR. The document was modified based on feedback from
expert peer reviewers. After cycles of review and revisions, the
statement was reviewed and formally approved by the Board of Directors
of the ATS and the Science Council and Executive Committee of the ERS.

Main Results:
This document articulates policy recommendations for advancing
healthcare professional, payer, and patient awareness and knowledge of
PR, increasing patient access to PR, and ensuring quality of PR
programs. It also recommends areas of future research to establish
evidence to support the development of an updated funding and
reimbursement policy regarding PR.

Conclusions:
The ATS and ERS commit to undertake actions that will improve access to
and delivery of PR services for suitable patients. They call on their
members and other health professional societies, payers, patients, and
patient advocacy groups to join in this commitment.

Sunday, November 22, 2015

Dear Respiratory Friends today we are very happy to present you great Inspirational book by Barbara Eyrich from Germany - Waiting Time: My life before and after the lung transplantation!!Several words about book from author Barbara Eyrich:This book is neither meant to be a medical treatise on my histology -
COPD / PULMONARY EMPHYSEMA - nor a guide or decision-making aid for or
against a lung transplant. It is also not supposed to be a pure boring
biography. Plus - it is furthermore not my intention to settle up with
anybody or cope with certain incidences, even if the one or other reader
might get this impression. The book simply describes this time of my
life: How the illness started, the waiting period prior to my
transplantation with all the preparations, and the wait for a donor
organ, the transplantation itself - and what happened afterwards.

How did I feel and do during this long WAITING TIME? There were
quite a few relapses I had to suffer from and to handle. How did I
manage to overcome them? What had helped me, and who was involved? How
did it happen that I had to decide on a transplantation? , and finally,
how did I continue after the surgery?
For some readers it will not be easy to cope with those details, as I
do come up with a lot of negative things. But: That's the way it was
and is - and therefore I have to describe how they happened and how my
overall condition is right now. Life, despite all positive thoughts and
desires, often turns out completely differently than expected in the
long- run. Such experiences cannot be found in any brochure, as life
writes an individual story for each human being.
All the names of people mentioned in this book have been changed,
abbreviated or made up in order to protect their identities.
Similarities in name of living persons are purely coincidental or have
been approved.
Please wait...! Isn't this something we all have experienced at some
point of time? Everyone reacts differently to these two words. One
bangs on the table, is not willing to wait and wants everything to be
instantly done. For the next one standing at the bus stop time gets too
long; he starts running off too early and eventually misses the bus
which arrives shortly after he has gone away and which leaves without
him. Someone else patiently endures the waiting time, though seething
inside. Yet another one deals with the waiting time, prepares for the
things to come and does not even realize how quickly or slowly time
passes by, and suddenly - the wait is over.
As for my book: I want to picture my story; how it all began with
the chronic disease COPD and the pulmonary emphysema, and all the ups
and downs. I will show you insight into my private and inner self, and
will describe the people who have accompanied me on my way: Clinical
personnel, doctors, physiotherapists, companions from my Lungensport
group (special breathing techniques), support groups, church, family,
friends, and neighbors, simply the entire social environment. During
this time, there was a lot I had to endure and to cope with; till this
very day I wonder how I was able to manage everything.

Wednesday, November 18, 2015

World COPD Day is organized by the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) in collaboration with health care
professionals and COPD patient groups throughout the world. Its aim is
to raise awareness about chronic obstructive pulmonary disease (COPD)
and improve COPD care throughout the world
Each year GOLD chooses a theme and coordinates preparation and distribution of World COPD Day materials and resources. World COPD Day activities are organized in each country by health care professionals, educators, and members of the public who want to help reduce the burden of COPD.
The first World COPD Day was held in 2002. Each year organizers in
more than 50 countries worldwide have carried out activities, making the
day one of the world's most important COPD awareness and education
events.

World COPD Day 2015 is taking place on Wednesday, November 18
around the theme “It’s Not Too Late.” This positive message was chosen
to emphasize the meaningful actions people can take to improve their
respiratory health, at any stage before or after a COPD diagnosis.

Saturday, November 14, 2015

World Diabetes Day, on the 14th November every year, has grown from humble beginnings to become a globally-celebrated event to increase awareness about diabetes.

Comprising hundreds of campaigns, activities, screenings, lecture,
meetings and more, World Diabetes Day is proving internationally
effective in spreading the message about diabetes and raising awareness
for the condition.

The theme of World Diabetes Day, from 2014 to 2016 will be healthy
living and diabetes and this year, there’s a focus on starting each day
right by having a healthy breakfast.

A healthy breakfast should help blood sugar levels from
getting too high and should keep you full through the morning. Whilst
cereal and toast may be cheap, these options typically raise blood sugar
levels rapidly and may leave you hungry again before lunch.

Friday, November 6, 2015

The ERS
Task Force on the Diagnosis and Management of Obstructive
Sleep-Disordered Breathing (SDB) in Childhood has published a new
document detailing a stepwise management approach for SDB in children
aged 2–18.

The
seven-step management approach covers topics such as reported symptoms,
morbidities, treatment indications and follow-up evaluations. The
document also takes into account the available diagnostic facilities and
accepted treatment policies in different European countries, describing
diagnostic modalities that can be used as alternatives for settings
where polysomnography is not available.

This document summarises the conclusions of a European Respiratory
Society Task Force on the diagnosis and management of obstructive sleep
disordered breathing (SDB) in childhood and refers to children aged
2–18 years. Prospective cohort studies describing the natural history of
SDB or randomised, double-blind, placebo-controlled trials regarding
its management are scarce. Selected evidence (362 articles) can be
consolidated into seven management steps. SDB is suspected when symptoms
or abnormalities related to upper airway obstruction are present (step
1). Central nervous or cardiovascular system morbidity, growth failure
or enuresis and predictors of SDB persistence in the long-term are
recognised (steps 2 and 3), and SDB severity is determined objectively
preferably using polysomnography (step 4). Children with an
apnoea–hypopnoea index (AHI) >5 episodes·h−1, those with an AHI of 1–5 episodes·h−1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g.
Down syndrome and Prader–Willi syndrome) all appear to benefit from
treatment (step 5). Treatment interventions are usually implemented in a
stepwise fashion addressing all abnormalities that predispose to SDB
(step 6) with re-evaluation after each intervention to detect residual
disease and to determine the need for additional treatment (step 7).

Saturday, October 31, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Stroke as a Consequence of Sleep Apnea: Epidemiology, Pathophysiology and Treatment Strategieswritten by our friends from Greece: Silvia V. Dumitru and Epameinondas N Kosmas.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: The links between Sleep Apnea and Chronic Kidney Diseasewritten by international team: Marius Balint Gib, Christophe Aron, Svetlana Ilie, Frederic Wallyn, Macha Tetart, Dumitrita Balint Gib.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Friday, October 30, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Overlap Syndrome of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea: A two-faced Janus written by our team: Alexandru Corlateanu, Victor Botnaru, Alexander G. Mathioudakis, Victoria Sircu, Nikos Siafakas.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Thursday, October 29, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Pregnancy and Sleep Apnea written by our friends from Greece Mastrodima-Polychroniou Sofia and Panoulis Konstantinos.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Wednesday, October 28, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Obesity and Body fat Distribution as Predictors for Obstructive Sleep Apnea Syndrome written by our friends from Romania Stefan Mihaicuta, Izabela Anita Toth, Sorin Paralescu, Carmen Ardelean, Stefan Marian Frent and Oana Claudia Deleanu.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Tuesday, October 27, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Sleep Apnea and Coronary Heart Disease: from Dusk Till Dawn and Further written by our friends from Greece Andriana Papaioannou, Konstantinos Kostikas, Spyros Papiris.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Monday, October 26, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Obstructive Sleep Apnea and Type 2 Diabetes: Dual Interaction written by our team from Moldova and Italy Alexandru Corlateanu, Victor Botnaru, Victoria Sircu, Serghei Covantev, Gloria Montanari.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Saturday, October 24, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews
dedicated to Sleep Apnea and comorbidities: Obstructive Sleep Apnea and Hypertension: A Bidirectional Causal Relation written by our Greek Friends Victoria Chatzimavridou-Grigoriadou, Alexander G. Mathioudakis, Alexandru Corlateanu, Georgios A. Mathioudakis and Efstathia Evangelopoulou.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Friday, October 23, 2015

We are happy to present you one of the articles from hot-topic issue of Current Respiratory Medicine Reviews dedicated to Sleep Apnea and comorbidities: Relation between Obstructive Sleep apnea Syndrome and Resistant Hypertension - the Tip of the Iceberg written by our Romanian Friends Oana Claudia Deleanu, Ana-Maria Nebunoiu, Miruna Mihaela Micheu, Andra Elena Malaut and Florin Dumitru Mihaltan.

This proposed hot-topic issue of Current Respiratory Medicine Reviews
is an update on the assessment of the main comorbidities and management
of patients with OSAS and comorbidities (hypertension, obesity,
diabetes, stroke, heart failure, COPD, chronic kidney disease).

Friday, October 16, 2015

Current Respiratory Medicine Reviews publishes original
research papers, frontier reviews, drug clinical trial studies and guest
edited issues dedicated to clinical research on all the latest advances
on respiratory diseases and its related areas e.g. pharmacology,
pathogenesis, clinical care, therapy. The journal is essential reading
for all researchers and clinicians in respiratory medicine.

Sunday, October 11, 2015

These days masterpiece L.O.V.E. (Milan, Italy) by famous Italian artist Maurizio Cattelan was laying with the pink ribbon for Breast Cancer Awareness! Action was organised by Lega Tumori Lilt Milano!

The controversial monument is made in marble, about 4 meters high and
has been allocated on a base that brings the sculpture to a total height
of 11 meters. during the making process, the famed italian artist
changed the title from ‘omnia munda mundis’ – literally meaning ‘to the
pure [men], all things [are] pure’, a latin sentence that has entered a
relatively common usage in many countries – to ‘L.O.V.E.’

Saturday, October 10, 2015

Kidneys, liver, heart, lungs... while transplantation medicine is
constantly developing, 70,000 people in the EU alone are still on
waiting lists for a transplant, making the lack of organs the main
obstacle to transplant medicine. In 2014, 12 people every day died, 12
people died because of the lack of available organs.

The Council of Europe is working tirelessly to promote the ethical
aspects, such as the respect of donors and receivers, and the
non-commercialisation of human organs, tissues and cells.

The idea behind this Day, initiated by the Council of Europe, is to
help a different member state each year to encourage debate and provide
information on organ donation and transplantation, legal and medical
measures so that each person can decide on donation and make their
wishes known to their family.

It is about helping member states to promote organ donation and
transplantation, and mobilise hospitals and professionals on the
identification of potential donors. It is also an opportunity to honour
all organ donors and their families and to thank transplantation
professionals throughout Europe whose hard work helps saving lives and
improving the quality of life of many people.

Friday, October 9, 2015

Dear Friends we are happy to present you fresh analysis of The Global Initiative for Asthma (GINA) Guidelines 2015.

The Global Initiative for Asthma (GINA) represents a remarkable source
document that has changed the course of asthma in most countries. The
first asthma guidelines have been published in Australasia, UK and the USA. Canadian and French recommendations proposed the concept of control, and the National Asthma Education and Prevention Program Expert Panel Report initiated the concept of risk for asthma.

However, GINA is globally considered to be the prominent asthma
recommendation building on existing knowledge and providing several
updates or revisions since it was introduced in 1995.
GINA 2015 represents a significant advance over the previous iteration,
with a more practical approach and an increased appreciation of asthma
as a public health problem.
Due to the expected impact of GINA 2015 it is mandatory to assess
strengths and weaknesses although many of these cannot be ruled out due
to the lack of information currently available.

Monday, October 5, 2015

Dear Friends, in American
Journal of Respiratory and Critical Care Medicine appeared new article on concepts of asthma!Our understanding of asthma has evolved over time from a
singular disease to a complex of various phenotypes, with varied natural
histories, physiologies, and responses to treatment. Early therapies
treated most patients with asthma similarly, with bronchodilators and
corticosteroids, but these therapies had varying degrees of success.
Similarly, despite initial studies that identified an underlying type 2
inflammation in the airways of patients with asthma, biologic therapies
targeted toward these type 2 pathways were unsuccessful in all patients.
These observations led to increased interest in phenotyping asthma.
Clinical approaches, both biased and later unbiased/statistical
approaches to large asthma patient cohorts, identified a variety of
patient characteristics, but they also consistently identified the
importance of age of onset of disease and the presence of eosinophils in
determining clinically relevant phenotypes. These paralleled molecular
approaches to phenotyping that developed an understanding that not all
patients share a type 2 inflammatory pattern. Using biomarkers to select
patients with type 2 inflammation, repeated trials of biologics
directed toward type 2 cytokine pathways saw newfound success,
confirming the importance of phenotyping in asthma. Further research is
needed to clarify additional clinical and molecular phenotypes, validate
predictive biomarkers, and identify new areas for possible
interventions.

Saturday, October 3, 2015

Dear friends Chest just published new Guidelines on Unexplained chronic cough!Background:Unexplained chronic cough (UCC) causes significant quality of
life impairment. There is a need to identify effective assessment and
treatment approaches for UCC.

Methods:This systematic review of randomized controlled clinical
trials asked: What is the efficacy of treatment compared to usual care
on cough severity, cough frequency, and cough-related quality of life in
patients with unexplained chronic cough (UCC)? Studies of adults and
adolescents >12 years with a chronic cough of >8 weeks duration
that was unexplained after systematic investigation and treatment were
included and assessed for relevance and quality. Based upon the
systematic review, guideline suggestions were developed and voted upon
using CHEST organization methodology.Results:11 RCTs and 5 systematic reviews were included. The 11 RCTs
reported data on 570 participants with chronic cough who received a
variety of interventions. Study quality was high in 10 RCTs. The studies
used a variety of descriptors and assessments to identify unexplained
chronic cough. While gabapentin and morphine showed positive effects on
cough-related quality of life, only gabapentin was supported as a
treatment recommendation. Studies of inhaled corticosteroids (ICS)
suffered from intervention fidelity bias, and when this was addressed,
ICS were not found to be effective for UCC. Esomeprazole was not
effective for UCC without features of gastroesophageal acid reflux.
Studies addressing non-acid gastroesophageal reflux were not identified.
A multimodality speech pathology intervention improved cough severity.Conclusions:The evidence supporting the diagnosis and management of UCC
is limited. UCC requires further study to establish agreed terminology
and the optimal methods of investigation using established criteria for
intervention fidelity. Speech pathology based cough suppression is
suggested as a treatment option for UCC. This guideline presents
suggestions for diagnosis and treatment based on the best available
evidence and identifies gaps in our knowledge and areas for future
research.Full text:http://journal.publications.chestnet.org/article.aspx?articleid=2451211&utm_content=buffer6c4ce&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

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